Deep buttock pain

What it is

The sciatic nerve leaves the pelvis through a gap in the buttock, passing directly beneath or occasionally through the piriformis muscle and among the other deep hip rotators. Compression or irritation anywhere in that space produces buttock pain that can refer down the leg.

It is worth distinguishing this from true sciatica from the spine, which they can closely resemble. Deep gluteal pain is typically worse sitting, tender to press deep in the buttock, and does not usually follow a crisp nerve-root pattern with numbness in a specific band of the foot. It is also considerably less common than spinal causes, which is why it is worth getting the assessment right.

What it feels like

• Deep aching in the middle of the buttock rather than in the back
• Much worse sitting, particularly on a hard seat or in a car
• Tender to press deep in the buttock, often reproducing the pain exactly
• Sometimes referring down the back of the thigh, less often past the knee
• Worse after prolonged sitting and eased by standing up and walking

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Compression of the sciatic nerve by the deep hip rotators

The nerve passes through a narrow space among the piriformis and the other deep rotators. Tightness, spasm or swelling in that group compresses it directly.

Sitting on a wallet

A genuinely common cause, sometimes called wallet neuritis. A thick wallet in a back pocket presses the nerve against the pelvis for hours a day.

Prolonged sitting

Hard seats, long drives and hours at a desk compress the buttock against the seat and hold the hip in a position that shortens the deep rotators.

Piriformis overwork from weak glutes

When the gluteus maximus and medius are weak, the deep rotators do more of the work of controlling the hip. An overworked deep rotator is a tight one, and it sits directly on the nerve.

Anatomical variation

In a minority of people the sciatic nerve passes through rather than under the piriformis, which raises susceptibility. It is a variation rather than an abnormality.

Hamstring tendon problems at the sitting bone

Proximal hamstring tendinopathy produces pain in the same region and is aggravated by exactly the same things. It is a common alternative explanation.

A previous fall onto the buttock

Direct trauma can leave scarring and lasting sensitivity in the deep gluteal space.

Running and hill work

Increased demand on the deep hip rotators from a rapid increase in running, particularly hills or trails, can precipitate it.

Spinal causes wearing the same disguise

Not a cause of this condition but the most important thing it is confused with. A lumbar disc or stenosis can produce identical buttock pain, and the treatment is different.

Who tends to get it

• Anyone who sits for long periods, especially on hard seats or in vehicles
• People who carry a wallet or phone in a back pocket
• Runners, particularly those increasing hill or trail work
• Anyone with weak glutes, which is most people who do not train them
• People with a history of a fall onto the buttock

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineSciatica & Deep Buttock Relief

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Numbness below the knee or foot drop points at a lumbar root instead - reassess

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Where the cause is positional - a wallet, a car seat, a chair - removing it often produces improvement within two weeks. Where it is a deep rotator overworking for weak glutes, strengthening takes six to twelve weeks. The main reason it becomes long-standing is misdiagnosis in either direction, so an assessment that distinguishes it from a spinal cause is worth having early. Progressive weakness, numbness in a specific foot pattern, or any bladder or bowel change points elsewhere and needs urgent attention.

Prevalence basis: Clinical series

Others the same routine covers

These share the Sciatica & Deep Buttock Relief routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.